Letter  on  the  Future  Location  of 


the  College  of  Physicians  and  Surgeons. 


[^>)R14-TC7 


A^ 


CoIuntWa  (Mnit>mttj) 

CoUese  ot  ^f^^iitmni  anb  ^urseonsi 
Hitirarp 


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[confidential 


Columliia  ^nitietgitp 
in  tije  Citp  of  i^eto  gork 


A    LETTER 

ON  THE 

FUTURE  LOCATION   OF  THE  COLLEGE  OF 

PHYSICIANS   AND   SURGEONS   AND 

THE  UNIVERSITY  HOSPITAL 


BY       ' 

FREDERIC  S:  LEE,  Ph.D. 

Dalton  Professor  of  Physiology 
AND 

FRANK  H.  PIKE,  Ph.D. 

Assistant  Professor  of  Physiology 


'^■^C—(^/f 


Columbia  ®nitiers;itp 

in  tfje  Citj)  of  i^eto  gorfe 


Columbia  University, 

April  9,  1913- 

Nicholas  Murray  Butler,  LL.D.,  President, 

Dear  Sir:  The  alliance  of  Columbia  University  and  the 
Presbyterian  Hospital  and  the  consideration  of  plans  for  the 
organization  and  building  of  the  hospital  have  brought  promi- 
nently into  the  foreground  the  whole  subject  of  the  future  of  the 
Columbia  School  of  Medicine.  As  members  of  the  teaching 
staffs  of  medicine  and  pure  science,  we  are  much  interested  in 
the  general  subject  and  its  discussion,  and  believing  that  it  has 
not  yet  been  viewed  in  all  its  aspects,  we  beg  to  present  the 
following  considerations. 

Most  of  the  schools  of  medicine  in  this  country  have  begun 
their  existence  as  independent  proprietary  institutions.  As  such 
they  naturally  acquired  the  habit  of  formulating  and  solving 
their  own  problems.  In  the  course  of  time,  however,  and  under 
the  influence  of  both  American  and  German  universities,  they 
have  come  to  realize  that  entire  independence  is  not  the  ideal 
condition  and  they  have  sought  or  accepted  university  connec- 
tions, a  relation  which  has  existed  in  Italy  for  several  centuries. 
In  some  cases  these  connections  are  nominal;  in  others  the 
schools  have  become  integral  parts  of  the  universities.  But  how- 
ever intimate  such  connections  may  be,  there  are  few  schools  if 
any  that  have  wholly  resigned  their  independent  habits  and  ac- 
cepted university  ideals  to  the  extent  that  schools  of  pure  science, 
law  and  political  science  have  accepted  them.  In  other  words, 
American  medical  schools  have  not  yet  come  to  realize  what  a 
university  affiliation  really  means.  Nor  on  the  other  hand  have 
universities  fully  appreciated  their  duties  to  their  adopted 
children. 


This  Is  the  situation  in  Columbia.     In  the  discussion  of  the 
problems  of  the  future  of  the  Columbia  School  of  Medicine 
stress  has  been  laid  heretofore  almost  exclu- 
Medical  School,     sively  upon  the  school  and  the  hospital  in  their 
Hospital  and         mutual  relations.    It  seems  to  have  been  over- 
University  looked  that  three  elements  are  involved :  the 
medical  school,  the  hospital,  and  the  rest  of 
the  university.    But  if  the  ideal  of  development  is  to  be  attained 
all  of  these  elements  must  be  taken  into  account :  the  functions  of 
the  medical  school  are  not  properly  limited  to  itself  and  the 
hospital,  nor  are  those  of  the  university  limited  to  itself  and  the 
school;  the  university  neither  does  its  whole  duty  nor  receives 
its  whole  benefit  by  simply  lending  the  weight  of  its  authority 
to  an  adjustment  of  relations  between  the  two  other  institutions. 
A  medical  school  of  the  broad  type  ought  not  to  exist  alone  for 
the  training  of  young  men  to  be  doctors, — it  falls  short  of  one 
of  its  highest  functions  if  it  does  not  serve  as  a  means  of  train- 
ing men  of  science.    A  hospital  of  the  broad  type  ought  not  to 
exist  alone  for  the  immediate  care  and  possible  cure  of  the  sick, 
— a  higher  function  is  the  scientific  study  of  diseased  organisms 
and  the  discovery  of  means,  better  than  now  exist,  of  maintain- 
ing organisms  in  a  condition  of  health.     A  university  ought  to 
inspire  both  medical  school  and  hospital  with  its  largeness  of 
view,  and  in  turn  it  should  receive  from  both  a  new  conception 
of  the  breadth  of  its  opportunities  for  culture. 

It  is  customary  to  classify  the  various  branches  of  study  with 
which  a  medical  school  has  to  deal  into  the  medical  sciences, 
which  include  anatomy,  histology,  embryology,  physiology, 
physiological  chemistry,  pathology,  bacteriology  and  pharma- 
cology; and  the  clinical  subjects,  which  com- 
Medical  prise  medicine  and  surgery  not  only  in  their 

Sciences  and  general  aspects  but  in  their  many  subdivisions 

Clinical  Sub-  or  specialties.     In  the  customary  division  of 

jects  the  time  of  the  medical  student's  four  years, 

the  medical  sciences  are  usually  allotted  the 
first  two  years,  or  nearly  the  whole  of  them,  and  the  clinical 
subjects  the  last  two  years.    The  position  of  the  medical  sciences 

2 


in  the  university  at  the  present  time  is  peculiar.  Many  of  them 
were  born  and  have  passed  through  their  periods  of  infancy  and 
adolescence  in  the  protecting  arms  of  medicine.  They  have 
thus  acquired  ineradicable  medical  relations.  But  they  are  now 
mature  and  have  gone  far  beyond  medical  boundaries;  while 
their  medical  relations  still  exist  and  are  of  great  importance 
both  to  themselves  and  to  medicine,  medicine  is  no  longer  their 
chief  sphere.  This  is  eminently  true  of  anatomy,  histology,  em- 
bryology, physiology  and  physiological  chemistry,  which  have 
broadly  biological  affiliations  far  transcending  their  medical 
bearings.  The  same  is  true,  though  in  slightly  less  degree,  of 
bacteriology;  while  of  pathology  and  pharmacology,  though 
their  general  biological  relations  are  still  less  obvious,  these 
exist  and  are  bound  to  become  more  prominent  as  time  goes  on. 
For  the  purposes  of  the  school  of  medicine  all  of  these  sciences 
are  medical  sciences;  for  the  purposes  of  the  rest  of  the  univer- 
sity they  are  both  medical  and  pure  sciences.  The  departments 
to  which  they  belong  thus  have  a  two-fold  educational  function 
to  perform  in  the  university :  they  must  provide  instruction  both 
in  applied  science  to  students  of  medicine  and,  unless  their  ex- 
pensive equipments  are  to  be  duplicated,  in  pure  science  to  stu- 
dents of  science.  It  is  sometimes  difficult  for  men  of  medicine 
to  realize  that  the  medical  sciences  are  no  longer  preeminently 
medical  In  their  relations,  and  by  many  clinicians  they  are  merely 
tolerated  In  the  medical  school  as  affording  a  supposedly  neces- 
sary preparation  for,  but  as  strictly  subordinate  to,  the  real 
business  of  medical  life.  While  their  followers  are  expected  to 
engage  In  scientific  research  as  well  as  to  teach,  their  Investiga- 
tions are  expected  to  be  more  or  less  "practical"  In  that  they 
should  have  some  immediate  relation  to  clinical  medicine.  This 
is  a  wholly  anomalous  condition.  It  is,  however,  plain  that  the 
position  of  the  so-called  medical  sciences  In  the  university  Is  dif- 
ferent from  that  of  the  clinical  subjects.  The  proper  status  of 
the  former  ought  to  be  recognized  by  the  university,  and  they 
should  be  given  opportunities  for  broad  development.  This 
should  be  given  due  weight  in  solving  the  problem  of  the 
location  of  the  future  school  of  medicine  of  Columbia. 


There  are  various  localities  in  which  the  future  school  of 
medicine  may  conceivably  be  housed.  It  may  remain  indefi- 
nitely, without  a  hospital,  in  West  59th 
Possible  Loca-  Street;  the  medical  sciences,  with  the  excep- 
tions of  Medical  tion  of  pathology,  may  remain  in  59th  Street 
School  or  may  be  removed  to  Morningside  Heights 

in  case  medicine,  surgery  and  pathology  are 
removed,  as  has  been  suggested,  to  the  proposed  new  Presby- 
terian Hospital  on  the  East  River;  the  entire  school  may  be 
located  at  the  site  of  the  Presbyterian  Hospital  on  the  East 
River;  the  entire  school  and  an  adequate  hospital  may  be  situ- 
ated, as  was  once  contemplated,  at  Morningside  Heights. 
These  possibihties  may  now  be  considered  seriatim. 

First.  The  school  of  medicine  may  remain  indefinitely, 
without  a  hospital,  in  West  3gth  Street.  This  proposition  need 
not  detain  us.  The  obvious  facts  that  the 
Continuation  of  school  has  outgrown  its  present  buildings  and 
School  in  59th  that  it  requires  a  hospital  for  its  proper  future 
Street  development,    are   sufficient   reasons    for  the 

termination  of  the  present  conditions  and  re- 
moval to  a  new  site.  Even  the  acquisition  of  the  Roosevelt 
Hospital,  long  regarded  as  a  possibility,  would  not  properly 
solve  the  problem.  Our  reasons  for  this  opinion  may  be  learned 
by  a  perusal  of  the  discussion  of  the  third  and  fourth  proposi- 
tions, for  the  points  there  raised  apply  with  almost  equal  force 
to  a  continuance  of  the  school,  with  a  hospital  alliance,  in  59th  St. 
Second.  The  medical  sciences,  with  the  exception  of  pa- 
thology, may  remain  in  SQth  Street,  or  may  he  removed  to 
Morningside  Heights  in  case  medicine,  sur- 
Separation  of  gery  and  pathology  are  removed,  as  has  been 
Medical  Sci-  suggested,  to  the  proposed  new  Presbyterian 

ences  from  Hospital  on  the  East  River.     This  proposi- 

Clinical  Sub-  tion  deserves  serious  consideration,  for  it  in- 

jects volves  a  fundamental  change  of  policy  on  the 

part  of  the  university,  namely:  the  geographi- 
cal separation  of  the  medical  sciences  and  the  clinical  subjects 
and  a  complete  change  of  academic  residence  of  the  student  of 

4 


medicine  in  the  middle  of  his  four  years.  In  various  American 
universities  such  a  condition  exists,  notably  at  Bowdoin,  Cali- 
fornia, Chicago,  Indiana,  Kansas,  Leland  Stanford,  Mississippi 
and  Nebraska.  In  all  of  these  institutions  the  instruction  of 
the  whole,  or  nearly  the  whole,  of  the  first  two  years  is  given  at 
the  main  site  of  the  universities,  while  the  clinical  work  is  per- 
formed at  the  more  or  less  distant  medical  schools.  The  same 
is  true  in  part  for  Cornell  University,  since  some  of  its  students 
are  allowed  to  take  their  first  two  years  at  Ithaca,  while  all  stu- 
dents must  take  the  final  two  years  in  New  York.  Moreover, 
the  medical  schools  of  Wake  Forest,  and  the  universities  of 
Missouri,  North  Carolina,  South  Dakota,  Utah,  West  Virginia 
and  Wisconsin  are  so-called  half  schools,  offering  instruction  in 
the  medical  sciences  only  and  obliging  their  graduates  to  seek 
clinical  Instruction  in  other  institutions. 

The  effects  of  such  geographical  separation  may  be  consid- 
ered from  the  point  of  view,  first,  of  the  students  and,  secondly, 
of  the  faculty. 

If  the  first  two  years  of  the  course  are  to  be  spent  in  physical 
separation  of  the  student  from  both  the  university  and  the  site  of 
the  clinical  instruction,  there  is  little  If  any- 
Separation  thing  to  be  said  in  favor  of  the  plan.     It  is 

from  Point  of       thoroughly  bad.     If  the  first  two  years  are 
View  of  spent  in  a  reputable  university,  certain  advan- 

Students  tages  from  the  point  of  view  of  the  student 

of  those  years  are  possible.  Such  a  plan 
would  mean  an  added  two  years'  contact  with  the  university  be- 
yond the  preparatory  two  years  of  college  work  which  all  the 
better  medical  schools  of  the  country  now  require.  These  added 
years  would  tend  to  give  the  student  a  broader  view  of  science 
and  would  imbue  him  more  thoroughly  with  academic  ideals- 
He  would  mingle  not  only  with  his  fellow  medical  students,  but 
with  others  who  would  be  studying  the  same  subjects  because  of 
their  academic  Interest  without  reference  to  their  future  appli- 
cation in  a  technical  career,  and  such  Intercourse,  if  these  latter 
associates  were  serious  scientific  students,  would  afford  a  distinct 
advantage.    The  student  of  medicine  would  have  his  time  free 


for  the  study  of  the  laboratory  subjects  without  behig  tempted 
to  attend  medical  and  surgical  clinics  and  experience  the  thrill 
of  procedures  which  he  could  not  comprehend.  He  would  be 
urged  to  acquire  a  broad  knowledge  of  his  subjects,  so  that  he 
might  have  a  basis  for  their  more  rational  application  when  he 
undertook  clinical  work.  The  amount  of  such  knowledge  which 
is  susceptible  of  clinical  application  Is  of  course  very  much 
greater  than  the  student's  capacity  of  acquisition  in  two  years. 
Nevertheless,  he  would  be  far  removed  from  the  notion  that 
everything  he  learned  must  have  some  Immediate  application  in 
clinical  medicine  or  surgery  without  the  intervention  of  further 
mental  processes. 

But  whatever  advantages  from  association  with  the  university 
might  accrue  to  the  student  of  the  first  two  years,  the  effect  of 
geographical  separation  from  the  university  upon  the  student  of 
the  third  and  fourth  years  would  be  distinctly  disadvantageous. 
Cut  off  from  communication  with  the  laboratories  and  the  lab- 
oratory workers  of  the  earlier  period  and  subjected  to  a  purely 
clinical  atmosphere,  he  would  be  in  great  danger  of  acquiring 
the  mental  narrowness  which  too  often  characterizes  the  grad- 
uates of  the  purely  technical  school.  Too  often  the  main  fear 
of  the  purely  technical  school  is  that  the  art,  rather  than  the 
science,  may  be  lost.  This  fear  is  especially  likely  to  arise  in 
the  mind  of  the  Isolated  medical  student,  and  for  Columbia  de- 
liberately to  Isolate  its  medical  students  for  the  last  two  years 
from  all  except  the  purely  clinical  environment,  would  be 
equivalent  to  saying  to  those  students  that  they  were  entitled 
only  to  whatever  prestige  might  accrue  to  them  from  associa- 
tion with  the  name  of  the  university,  but  that  the  benefits  aris- 
ing from  the  closest  possible  association  with  the  best  that  the 
university  has  to  offer  should  be  denied  to  them,  except  at  the 
cost  of  much  time  and  great  labor. 

In  considering  the  question  of  physical  separation  from  the 
point  of  view  of  the  faculty,  we  may  Inquire  into  the  relations 
of  those  members  of  the  faculty  who  represent  the  medical 
sciences,  both  to  the  representatives  of  the  other  sciences  of  the 
university  and  to  the  clinical  instructors. 

6 


The  instructors  In  the  medical  sciences  constitute  a  body  of 
men  who  are  devoted  partly  to  the  discovery  and  the  teaching  of 
the  facts  and  principles  of  pure  science,  and 
Separation  partly  to  the  application  of  such  facts   and 

from  Point  of  principles.  In  physiology,  as  an  example,  the 
View  of  chief  task  of  the  investigator  is  the  explanation 

Faculty  of  the  processes  in  living  matter  on  the  basis 

of  known  facts  in  physics  and  chemistry.  The 
nature  of  matter  and  the  structure  of  the  carbon  atom  are  not  of 
primary  interest  to  him  as  subjects  for  investigation,  but  are  of 
interest  as  a  basis  for  the  explanation  of  the  deportment  of  liv- 
ing matter.  The  progress  of  physiological  science  in  certain  di- 
rections is  limited  by  the  state  of  advancement  in  the  fundamen- 
tal physical  sciences.  The  closest  contact  with  physicists  and 
chemists  is  necessary  if  the  physiologist  is  to  keep  his  ideas  clear 
with  reference  to  developments  in  these  sciences.  Without  such 
clarity  of  fundamental  ideas,  no  proper  or  correct  extension  of 
them  to  the  phenomena  of  living  matter  is  possible.  Again,  the 
physiologist  may  search  for  new  relationships  of  the  parts  of  the 
organism  to  each  other,  or  of  organisms  to  their  environment. 
All  this  knowledge  may  tend  toward  the  enlightenment  of  the 
clinician,  affording  him  a  better  basis  for  the  explanation  of 
diseased  conditions  and  occasionally  suggesting  a  means  of  treat- 
ment. The  laboratory  worker  may  also  desire  to  test  his  ex- 
perimental results,  obtained  for  the  most  part  from  the  study  of 
animals,  by  the  observation  of  human  patients,  and  to  this  ex- 
tent he  becomes  a  worker  in  applied  science. 

The  clinician  is,  or  should  be,  the  chief  worker  in  the  applica- 
tion of  experimental  types  and  methods  to  diseased  conditions. 
From  the  nature  of  his  occupation,  he  is  more  or  less  completely 
excluded  from  the  pursuit  of  pure  science  and  is  dependent  upon 
the  laboratory  worker  for  his  knowledge  of  the  fundamental 
facts  without  which  their  clinical  application  is  impossible. 
Thus  intelligent  or  rational  progress  in  clinical  medicine  is  de- 
pendent upon  progress  in  the  experimental  medical  sciences. 
The  clinician  who  prides  himself  upon  being  thoroughly  prac- 
tical often  thinks  he  has  attained  his  goal  when  he  is  able  to 

7 


diagnose  the  conditions  existing  in  his  patients  and  to  prescribe 
for  them  according  to  the  accepted  methods  of  the  day.  But  if 
the  restoration  of  the  patient  to  health  be  the  standard  by  which 
the  practicability  of  the  results  is  judged,  the  high  death 
rate  in  early  life  and  the  frequent  occurrence  of  incurable  dis- 
ease testify  to  the  inefficiency  of  existing  clinical  methods  and 
compel  the  reluctant  admission  that  the  so-called  practical 
medicine  of  to-day  is  grossly  impractical.  The  really  practical 
man  in  any  line  of  human  endeavor  is  he  who  is  able  not  only 
to  do  things  as  well  as  any  one  else,  but  to  apply  his  theoretical 
knowledge  in  the  development  of  new  methods  and  the  acquisi- 
tion of  new  results  in  his  particular  field.  The  great  body  of 
scientific  knowledge  acquired  by  laboratory  workers  constantly 
affords  discerning  clinicians  points  capable  of  practical  applica- 
tion. The  more  thoughtful  clinicians,  indeed,  are  now  seeking 
the  laboratory  in  ever  increasing  numbers.  The  real  problem 
of  the  man  of  medicine — the  successful  treatment  of  diseased 
conditions  and  the  restoration  of  the  patient  to  health — is  one 
of  surpassing  difficulty.  In  the  development  of  preventive 
medicine  has  there  been  the  greatest  and  most  uniform 
success,  and  here  knowledge  of  the  biology  of  the  disease-pro- 
ducing agents  gained  from  a  laboratory  study  has  clearly  been 
Indispensable.  The  growing  tendency  of  clinicians  to  return  to 
the  laboratory  Indicates  a  recognition  by  them  of  the  kind  of 
knowledge  that  is  of  most  worth  in  the  really  constructive  work 
of  the  practitioner  of  medicine. 

With  the  growth  of  the  laboratory  subjects  and  the  refine- 
ment of  laboratory  methods  of  examination,  the  clinician's  ca- 
pacity for  assimilation  becomes  exceeded,  and  even  now  the  fre- 
quent necessity  Is  upon  us  of  the  examination  of  patients  by 
trained  workers  not  primarily  clinicians,  who  have  acquired 
skill  and  knowledge  of  their  subjects  by  long  and  careful  labora- 
tory study.  This  necessity  will  steadily  increase  in  the  future, 
and  must  be  met  if  medicine  Is  to  attain  Its  highest  usefulness  as 
a  curative  art. 

Thus  contact  with  laboratory  workers  Is  a  sine  qua  non  for 
the  modern  clinician,  twice  removed  as  he  Is  from  the  funda- 


mental  sciences.  The  laboratory  worker  on  the  other  hand 
may  survive  without  actual  contact  with  human  patients,  al- 
though his  efficiency  will  be  impaired;  but  the  progress  of  medi- 
cine will  surely  be  impeded  by  the  physical  separation  of  the  two 
clinical  years  from  the  two  laboratory  years,  or  the  indifference 
of  the  clinician  to  progress  in  the  laboratory  subjects,  which  is 
likely  to  grow  out  of  such  a  physical  separation.  In  short,  the 
physical  separation  of  the  laboratory  and  clinical  years  is  an  al- 
most impassable  barrier  to  clinical  progress. 

Other  considerations  based  on  any  scheme  that  involves  the 
geographical  separation  of  the  medical  sciences  and  the  other 
scientific  departments  of  the  university  will  be  presented  under 
the  third  and  fourth  propositions  below. 

Third.  The  entire  school  of  medicine  may  be  located  at  the 
site  of  the  Presbyterian  Hospital  on  the  East  River.  The  one 
great  advantage  to  the  medical  school  of  this 
Hospital  Alii-  location  at  the  site  of  the  Presbyterian  Hos- 
ance  not  Ideal  pital  would  be  that  the  school  would  thus  ob- 
tain for  its  exclusive  use  an  adequate  hospital. 
But  the  existing  union  of  the  university  with  the  hospital  is 
merely  an  alliance,  and  not  an  amalgamation.  When  two  sepa- 
rate corporations  exist  and  the  personnel  of  the  governing  board 
of  each  is  distinct  from  that  of  the  other,  it  is  inevitable  that 
even  with  the  best  of  intentions  serious  differences  of  opinion  as 
Jtoi  policy  and  procedure  will  arise.  Such  an  association  is  far 
from  ideal.  The  ideal  relation  can  only  be  one  in  which  the 
university  is  able  to  exercise  absolute  control  in  the  administra- 
tion of  the  hospital,  and  it  is  this  ideal  relation  alone  to  which 
the  university  ought  to  look  forward. 

In  advocacy  of  the  site  on  the  East  River  emphasis  has  often 
been  laid  on  the  advantages  that  would  accrue  to  the  school 

,,  ,.  ,  ^  ,  ,  from  proximity  to  the  Rockefeller  Institute. 
Medical  School      t^t     i    v  i         >  i       i 

,  _.  ,  ^  „  VVe  believe  that  these  supposed  advantages 
and  Rockefeller  .  ,      _,      ^f  f 

^      .  are  over-estimated.     1  here  is  no  reason  to  be- 

lieve that  the  school  could  ever  form  an  al- 
liance of  any  kind  with  or  obtain  any  special  privileges  from 
the    institute.      A    certain    amount    of    helpfulness    doubtless 

9 


would  come  to  the  investigators  in  the  school  from  associa- 
tion with  their  fellow  investigators  in  the  next  block.  But 
the  two  groups,  both  working  in  scientific  medicine,  would  be  in 
a  certain  sense  rivals,  if  only  unconsciously  so;  and  it  is  a  ques- 
tion whether  the  prestige  of  the  institute  as  a  purely  research 
institution  would  not  overshadow  that  of  the  school  and  place 
it  in  a  position  of  inferiority  and  dependency. 

In  his  "Memorandum  on  the  Ideal  Development  of  Hospital 
and  Medical  School,"  Dean  Lambert  has  presented  three  ob- 
jections  to    the   proposed   site    on   the    East 
Dean  Lam-  River,  namely:   (i)    "The  present  com.para- 

bert's  Objec-  tive  inaccessibility  of  this  East  River  site  both 
tions  for  patients  and  for  the  friends  and  patrons 

who  are  the  sources  of  the  hospital's  financial 
support" — an  objection  the  weight  of  which  has  not  been  sufii- 
clently  appreciated  and  which  there  is  no  reason  to  believe  would 
ever  be  removed;  (2)  the  new  site  of  the  Presbyterian  Hospital 
"is  not  in  its  present  limited  ambulance  district  and  it  has  no 
guarantee  of  having  any  ambulance  service  at  all," — a  serious 
objection;  (3)  the  existing  restrictions  against  the  erection  of  a 
building  suflSIcIently  high  to  satisfy  the  needs  of  the  future  hos- 
pital, and  the  impossibility  of  securing  land  north  of  the  site 
except  at  a  prohibitive  cost.  These  three  objections  have  not 
yet  been  satisfactorily  answered. 

We  can  foresee  one  lamentable  result  which  would,  we  be- 
lieve, inevitably  follow  from  the  removal  of  the  entire  medical 
school   to   the    East    River   site.     We   have 
Medical  Sci-  pointed   out   that   the   so-called   medical   sci- 

ences and  ences,  while  medical  for  the  purposes  of  medi- 

School  of  Pure  cine,  are  at  the  same  time  pure  sciences  for  the 
Science  rest  of  the  university.     In  accordance  with 

this  latter  aspect  the  departments  represent- 
ing them  provide  Instruction  and  opportunities  for  research  for 
graduates  in  the  School  of  Pure  Science  who  are  studying  to- 
ward the  degrees  of  A.M.  and  Ph.D.  This  is  true  of  anatomy, 
physiology,  physiological  cTiemlstry,  pathology,  bacteriology 
and  pharmacology.     Most  of  the  students  working  along  these 

10 


purely  scientific  lines  give  a  portion  of  their  time  to  other  scien- 
tific work  at  Morningside  Heights.  The  distance  between  59th 
Street  and  11 6th  Street  has  always  proved  a  serious  obstacle  to 
this  cooperative  work  and  has  cut  off  from  the  great  opportuni- 
ties presented  in  the  one  place  a  body  of  young  men  whose  pri- 
mary interests  lie  in  the  sciences  represented  in  the  other.  Thus, 
students  in  zoology  may  wish  to  take  certain  courses  in  anatomy 
or  physiology  or  physiological  chemistry,  or  vice  versa ;  students 
in  physiology  certain  courses  in  physics  or  psychology,  or  vice 
versa ;  students  in  botany  certain  courses  in  bacteriology,  or  vice 
versa.  The  present  distance  of  three  miles  separating  the  re- 
spective schools  has  often  proved  the  decisive  factor  in  nullify- 
ing the  student's  desires.  This  has  constantly  been  a  source  of 
complaint,  and  there  has  been  a  constant  wish  on  the  part  of  the 
instructors  in  the  science  departments  at  Morningside  Heights 
for  a  closer  proximity  of  the  laboratories  of  the  medical  sci- 
ences. Evidence  of  this  wish  is  presented  in  a  subsequent  por- 
tion of  the  present  communication.  The  removal  of  these  lab- 
oratories to  the  East  River  site  would  make  cooperation  still 
more  difficult,  and  would  probably  put  an  end  to  the  ambitions 
of  the  departments  of  the  medical  sciences  toward  an  honorable 
standing  in  the  school  of  pure  science.  From  the  time  of  re- 
moval anatomy,  physiology,  physiological  chemistry,  pathology, 
bacteriology  and  pharmacology  would  stand  for  naught  in  the 
scientific  councils  of  the  university.  This  would  be  seriously 
detrimental  not  only  to  the  best  interests  of  the  departments  im- 
mediately concerned,  both  those  in  the  medical  school  and  those 
at  1 1 6th  Street,  but  to  the  university  as  a  whole.  It  is  not  pos- 
sible for  us  to  look  with  complacence  upon  such  a  destruction  of 
our  hopes  of  seeing  these  departments  university  departments 
in  something  more  than  name.  They  ought  to  be  In  a  position 
to  share  In  directing  the  scientific  policies  of  the  university  and 
not  be  merely  appendages  to  clinical  medicine. 

That,  however.  If  removed  to  the  East  River,  they  with  the 
exception  of  pathology,  would  be  little  more  than  appendages 
to  clinical  medicine  Is  evident  from  the  plan  of  organization  of 
the  new  Presbyterian  Hospital  on  university  lines  which  has  been 

II 


proposed  by  a  committee  appointed  for  this  purpose.  This  com- 
mittee, consisting  of  Dean  Lambert  and  Professors  Blake,  Jane- 
way,  MacCallum  and  Longcope,  representing 
Organization  of  the  departments  of  medicine,  surgery  and 
Presbyterian  pathology,  presented  a  report  dated  March 

Hospital  29,  19 1 2,  in  which  was  outlined  an  elaborate 

plan  of  organization.  This  plan  pertains 
to  "the  physical  conditions  which  will  exist  during  the  con- 
tinuance of  the  school,  together  with  the  Sloane  Hospital 
and  the  Vanderbilt  Clinic,  at  its  present  location,"  and 
from  the  standpoint  of  routine  clinical  medicine,  surgery  and 
pathology  leaves  little  to  be  desired.  If,  however,  it  represents 
substantially  the  plan  of  the  ultimate  university  hospital  beside 
which  the  school  Is  to  be  situated,  it  has  defects  which  from  the 
standpoint  of  the  university  departments  of  the  medical  sciences 
are  most  serious,  for  none  of  these  departments,  with  the  ex- 
ception of  pathology,  Is  given  any  real  standing  in  the  hospital. 
The  plan  does  permit.  It  is  true,  that  "the  professors  of  chemis- 
try and  bacteriology  should  become  respectively  consulting 
chemist  and  consulting  bacteriologist  to  the  hospital;  and  if  they 
so  desire  may  have  facilities  for  carrying  on  investigation  in 
conjunction  with  the  director  of  the  medical  or  surgical  clinic" 
— a  plan  which  recognizes  the  departments  In  question  only  in 
the  most  formal  way  and  treats  them  as  accessory,  not  essential, 
parts  of  the  hospital  scheme.  The  entire  omission  of  the  other 
scientific  departments  Is  most  striking  In  the  case  of  physiology. 
The  plan  provides  for  separate  physiological  laboratories  and 
an  assistant  physician  In  charge  of  physiological  work.  This 
officer  is  to  be  nominated  after  consultation  with  the  head  of  the 
department  of  physiology  of  the  College,  and  may  also  hold  a 
position  in  that  department,  but  must  give  his  entire  time  to  the 
hospital  and  must  be  responsible  to  his  superiors  in  the  depart- 
ment of  medicine  only.  Not  only  Is  It  not  proposed  to  make  use 
of  the  rich  resources  of  the  department  of  physiology,  which 
must  in  the  nature  of  the  case  always  surpass  the  physiological 
resources  of  the  department  of  medicine,  but  there  is  no  pro- 
vision by  which  the  former  department  Is  allowed  access  to  the 

12 


many  interesting  cases  in  the  hospital,  which  will  constantly 
supply  invaluable  topics  of  research.  Physiological  science  is 
coming  more  and  more  to  need  human  beings  for  observation, 
and  as  the  medical  school  is  now  situated  in  59th  Street,  the 
Vanderbilt  Clinic  and  Roosevelt  Hospital  provide  for  the  de- 
partment of  physiology  abundant  cases  for  one  important  va- 
riety of  human  observation,  namely,  electrocardiographic 
study.  According  to  the  new  plan,  this  supply  of  patients 
would  be  cut  off,  and  this  important  phase  of  the  work  of 
the  department,  for  which  one  of  the  most  complete  equipments 
of  apparatus  existing  in  any  laboratory  of  the  world  has  been 
provided,  would  be  seriously  crippled.  The  necessity  for  the 
cooperation  of  the  clinical  and  laboratory  staffs  is  well  shown 
also  in  the  study  of  cases  of  nervous  and  mental  disease.  The 
problem  of  localization  of  function  is  one  of  the  most  important 
lines  of  work  on  the  nervous  system  at  the  present  time.  The 
approach  to  the  problem  lies  through  the  various  fields  of  anat- 
omy, comparative  and  embryological,  psychology,  both  animal 
and  human,  physiological  experimentation  on  all  forms  of  ani- 
mals, and  the  study  of  the  action  of  drugs  on  the  central  ner- 
vous system.  It  is  self-evident  that  the  acquisition  of  a  work- 
ing knowledge  of  all  these  subjects  lies  beyond  the  mental  ca- 
pacity of  any  one  man.  That  a  clinician  is  not  prepared  to  diag- 
nose and  treat  a  case  of  nervous  or  mental  disease  in  the  best 
possible  way  without  the  aid  of  investigators  in  all  these  lines  of 
work  is  equally  apparent. 

Any  plan  which  does  not  allow  the  close  cooperation  of  the 
university  departments  of  the  medical  sciences  and  the  clinical 
work  of  the  hospital  is  not  in  accord  with  the 
Organization  of     practice  of  certain  of  the  most  enlightened 
Other  modern  hospitals.    Thus  in  the  city  of  Cleve- 

Hospitals  land,  the  director  of  the  H.  K.  Gushing  Lab- 

oratory of  Experimental  Medicine  of  the 
Western  Reserve  University,  who  is  one  of  the  leading  Ameri- 
can physiologists,  has  a  regular  official  position  on  the  staff  of 
the  Lakeside  Hospital,  has  the  right  of  access  to  the  wards,  and 
is  constantly  engaged  in  legitimate  physiological  research  on  the 

13 


hospital  patients.  The  Peter  Bent  Brigham  Hospital  of  Bos- 
ton, which  is  closely  affiliated  with  the  Harvard  Medical  School, 
represents  the  latest  phase  of  hospital  construction  and  admin- 
istration. "The  entire  relation  between  the  Hospital  and  the 
Medical  School,"  writes  Dr.  Henry  A.  Christian,  the  physician- 
in-chief  of  the  Hospital,  "is  one  of  mutual  cooperation,  each 
reahzing  the  value  of  the  one  to  the  other."  Not  only  have  the 
present  heads  of  the  departments  of  pathology  and  biochemistry 
of  the  Medical  School  been  appointed  as  consulting  pathologist 
and  chemist  of  the  Hospital,  but  the  head  of  the  department  of 
physiology  has  become  consulting  physiologist,  and  "presum- 
ably the  professor  of  pharmacology  when  he  is  appointed  in 
the  School  will  hold  a  similar  relation."  Dr.  Harvey  Gushing, 
the  surgeon-in-chief  of  the  Hospital  writes  of  the  university 
representatives  of  the  medical  sciences : 

"I  should  myself  be  glad  to  see  these  men  have  posts  exactly 
equivalent  to  those  commonly  held  by  the  pathologist,  and  also 
to  receive  salaries  and  to  have  their  residents  like  the  rest  of  us. 
Anything  to  bring  the  school  and  clinic  near  together — this  is 
what  we  should  like  to  see  brought  about." 

Of  the  nature  of  the  hospital  position.  Dr.  Christian  writes 
as  follows: 

"Dr.  Cannon  in  his  position  as  consulting  physiologist  is  a 
member  of  the  Hospital  Staff,  and  it  is  our  wish  that  he  should 
have  general  oversight  of  the  routine  physiological  methods  of 
studying  patients.  He  is  not  to  receive  a  salary  for  his  work, 
but  in  our  general  plan  of  organization  it  was  provided  that  in 
case  this  work  should  so  develop  as  to  require  any  considerable 
amount  of  his  time,  salary  provision  should  be  made  for  it.  It 
has  been  our  hope  that  Dr.  Cannon  would  make  occasional 
rounds  in  the  wards  with  the  visiting  staff  to  keep  in  touch  with 
the  type  of  patients  and  to  make  suggestions  in  regard  to  their 
investigation  from  the  physiological  point  of  view.  Of  course 
he  will  have  freedom  to  conduct  physiological  investigations 
upon  patients  himself  or  indirectly  through  his  assistants.  Such 
hmitations  upon  such  work  as  seem  needed  from  the  clinical 
viewpoint  naturally  will  be  placed  by  the  physician-in-chief, 
who  is  responsible  for  the  health  and  treatment  of  all  patients." 

14 


It  is  thus  obvious  that  in  the  Brigham  Hospital  the 
cooperation  of  the  departments  of  the  medical  sciences  of  the 
Harvard  Medical  School  is  fully  sought,  and  these  departments 
are  given  certain  hospital  rights  and  not  mere  favors.  The  en- 
lightened university  hospitals  of  the  future  will  undoubtedly 
recognize  that  the  university  departments  of  the  medical  sci- 
ences, by  reason  both  of  the  more  accurate  and  extensive  knowl- 
edge of  the  subject  matter  possessed  by  the  members  of  their 
staffs  and  of  their  vastly  superior  laboratory  facilities,  are  the 
proper  directors  of  such  phases  of  the  hospital  work  as  come 
properly  within  the  pale  of  the  sciences  involved. 

Fourth.  The  entire  school  of  medicine  and  an  adequate 
hospital  may  be  situated,  as  was  once  contemplated,  at  Morning- 
side  Heights. 

This  fourth  proposition  makes  what  is,  to  our  minds,  the 
ideal  disposition  of  the  school  of  medicine. 

Tradition  is  always  hard  to  kill,  and  medical  tradition  is 
especially  so.  It  would  be  possible  to  cite  Innumerable  examples 
of  the  persistence  of  medical  notions  long 
Medical  Educa-  after  they  have  ceased  to  have  a  vital  bearing 
tion  an  Educa-  upon  medicine  itself.  So,  too,  there  is  no  edu- 
tional  Problem  cational  institution  existing  that  is  more  bur- 
dened by  the  weight  of  tradition  than  is  the 
medical  school.  In  his  sagacious  introduction  to  Mr.  Flexner's 
Report  to  the  Carnegie  Foundation  for  the  Advancement  of 
Teaching  on  Medical  Education  in  Europe,  President  Pritchett 
says:  "Medical  education  Is  first  of  all  an  educational,  rather 
than  a  professional,  problem.  .  .  .  This  distinction  is  an  Impor- 
tant one,  for  professional  education,  particularly  in  America,  has 
suffered  from  the  notion  that  to  train  a  man  for  his  profession, 
one  must  have  the  viewpoint  of  the  practitioner  only,  and  not 
the  viewpoint  of  the  teacher  as  well.  .  .  .  The  education  of  a 
physician  Is  primarily  an  educational,  not  a  medical  question, 
just  as  the  training  of  an  engineer  Is  primarily  an  educational, 
not  an  engineering  question."  In  the  past,  and  especially  In 
America,  medical  schools  almost  without  exception  have  been  or- 
ganized and  administered  by  practitioners  of  medicine,  while 

15 


by  far  the  most  of  the  Instruction  has  been  given  by  practition- 
ers. But  the  omnipotence  of  the  practitioner  is  already  waning. 
It  has  become  a  cardinal  principle  of  the  best  schools  that  the 
departments  of  the  medical  sciences  should  be  administered  and 
the  instruction  therein  should  be  given  chiefly  by  men  who  are 
not  medical  practitioners,  and  In  many  cases  such  men  have 
neither  had  a  clinical  training  nor  received  a  medical  degree. 
And  the  movement  has  now  begun  to  put  the  clinical  subjects 
likewise  in  the  hands  of  men  who  shall  not  practice  their  profes- 
sion outside  the  university  hospital.  President  Pritchett  again 
says  : 

"It  has  come  to  be  generally  conceded  that  not  only  must  the 
basic  sciences  of  chemistry,  physics,  and  biology  be  taught  by 
those  who  are  primarily  teachers  and  who  give  their  whole  time 
to  teaching  and  to  research,  but  also  that  the  more  definitely 
medical  sciences  of  anatomy,  physiology,  pathology,  and  bac- 
teriology must  be  represented  by  specialists.  It  has  not  been  so 
generally  granted  that  the  clinical  teacher  must  also  be  primarily 
a  man  who  devotes  his  life  to  teaching  and  to  research.  This 
reform  Is  the  next  great  step  to  be  taken  In  the  Improvement  of 
medical  education  in  the  United  States  and  Great  Britain.  In 
Germany  only  has  it  heretofore  found  recognition,  and  to  this 
fact,  next  to  the  development  of  an  orderly  and  efficient  system 
of  secondary  schools,  is  to  be  attributed  the  high  level  of  Ger- 
man medical  science  and  medical  teaching." 

Thus  Is  one  tradition  already  well-nigh  broken. 

Another  tradition  has  decreed  that  a  medical  school  shall  be 
located  In  the  midst  of  poverty  and  a  congested  population, 
where  clinical  opportunities  are  abundant,  and 
Medical  School  not  too  far  removed  from  the  private  offices 
and  Congested  of  the  practitioner  professors.  With  a  large 
Population  portion  of  the  teaching  staff  non-practltloners, 

the  location  of  the  private  offices  of  practi- 
tioners need  no  longer  be  of  moment.  The  tradition  of  the  im- 
mediate necessity  of  a  congested  population  cannot  endure  much 
longer.  The  experience  of  the  Vanderbilt  Clinic  and  other 
clinics  in  this  city  proves  that  ambulant  patients  will  travel  dis- 
tances of  even  many  miles  to  secure  the  best  medical  and  sur- 

i6 


gical  treatment,  provided  that  facilities  for  inexpensive  public 
transit  exist.  Mr.  Flexner  points  out  that  in  Germany  the  fame 
of  the  medical  professor  is  a  powerful  magnet  and  one  of  the 
important  factors  in  building  up  clinics  in  small  university  towns 
by  drawing  from  surrounding  regions.  Thus,  the  clinic  of 
Gottingen  with  a  municipal  population  of  34,081  possesses  458 
beds;  that  of  Greifswald  with  23,767  inhabitants  has  478  beds; 
that  of  Marburg  with  20,136  inhabitants  has  664  beds;  and 
that  of  Tubingen  with  16,809  inhabitants  has  881  beds.  Krehl's 
clinic  at  Heidelberg  is,  or  was  until  within  a  very  few  years,  the 
largest  medical  clinic  conducted  by  a  single  individual  in  the 
world.  All  these  facts  go  to  show  that  even  the  poor,  prone  as 
they  are  to  follow  charlatanism  and  ostentatious  display  of  the 
machinery  of  the  healing  art,  will  go  to  the  famous  clinics  if  any 
are  available. 

Thus  in  locating  the  ideal  school  of  medicine  of  the  future, 
other  than  the  traditional  reasons  ought  to  be  decisive.  We  are 
convinced  that  the  controlling  factor  should  be  the  location  of 
the  rest  of  the  university — where  the  rest  of  the  university  is 
situated,  there  should  be  its  school  of  medicine  and  its  hospital. 

The  two  functions  of  the  medical  school  are  teaching  and  re- 
search. In  the  minds  of  many  laymen  and  even  of  many  medi- 
cal men  the  function  of  teaching  should  be 
Teaching  and  preeminent  In  the  school:  it  Is  merely  a  tech- 
Research  nical  school  existing  for  the  purpose  of  train- 
ing practitioners  of  medicine  and  surgery. 
And  by  both  laymen  and  many  medical  men  the  success  of  a  fol- 
lower of  medicine  Is  often  measured  by  the  extent  of  his  prac- 
tice or  the  fame  of  his  success  in  diagnosing  or  treating  disease. 
Many  persons  are  prone  to  dwell  upon  certain  dramatic  mo- 
ments in  the  operating  theater  as  the  crowning  glory  of  a  sur- 
geon's Hfe.  It  Is  obvious  that  the  need  for  properly  trained 
practitioners  will  continue  to  exist,  and  the  medical  school  is  and 
must  remain  In  many  respects  a  technical  school,  where  the 
teaching  of  things  as  they  are  is  carried  on.  But  medicine  that 
Is  associated  solely  with  the  conventional  hospital  ward  and  the 
operating  room  or  the  private  practice  may  be,  and  too  often  is, 

17 


a  merely  static  thing.  The  medical  school  that  merely  teaches  is 
but  half  developed.  A  function  as  great  as,  or  perhaps  even 
greater  than,  teaching  and  more  useful  to  mankind  is  research. 
When  one  contemplates  the  success  and  the  just  fame  of  the 
medical  faculty  of  a  German  university  one  thinks  immediately 
of  its  contributions  to  scientific  medicine,  and  one  realizes  that 
because  of  its  spirit  of  investigation  it  is  enabled  to  educate  bet- 
ter practitioners  than  a  mere  teaching  body.  The  medical  school 
that  represents  the  ideal  is  undoubtedly  one  in  which  teaching 
and  research  are  coordinately  developed  and  in  which  practi- 
tioners and  investigators  aliUe  are  trained.  Within  such  a 
school  teaching  and  research  should  not  be  separated  as  between 
departments.  Research  should  no  more  be  limited  to  the  medi- 
cal sciences  than  should  the  clinical  subjects  be  limited  to  teach- 
ing. Each  department  should  be  a  teaching  and  an  investigat- 
ing center.  In  the  College  of  Physicians  and  Surgeons  research 
at  present  is  limited  chiefly  to  the  medical  sciences,  in  all  of 
which  abundant  and  worthy  research  is  being  carried  on.  Un- 
der the  stimulating  influence  of  the  present  heads  of  the  depart- 
ments of  practice  of  medicine  and  surgery  there  has  been  a 
gratifying  development  of  the  research  spirit  among  a  few 
members  of  the  staffs  of  those  departments.  In  the  other  clini- 
cal subjects  research  is  largely  wanting. 

But  teaching  and  research  are  the  proper  functions  of  every 
school  of  a  university  and  of  every  department  within  a  school. 

No  distinction  can  or  ought  to  be  made  in  this 
Benefits  of  As-  respect  between  the  medical  school  and  the 
sociation  of  rest  of  the  university.     It  goes  without  saying 

Medical  School  that  the  ideal  environment  for  an  institution 
and  University      devoted  to  teaching  and  research  is  that  of 

other  institutions  of  like  function.  Academic 
isolation  invariably  results  in  narrowness  and  infertility.  It  has 
thus  become  customary  to  associate  geographically  as  closely  as 
possible  the  component  schools  of  a  university,  and  thus  to  make 
possible  the  intimate  association  of  the  men  who  perform  its 
great  functions.  Such'  intimate  association  is  one  of  the  most 
important  features  in  the  work  of  a  university,  for  it  breeds  a 

i8       . 


constant  interchange  of  ideas,  a  broadening  of  knowledge,  a 
stimulating  inspiration,  and  an  encouragement  of  effort.  More- 
over, it  allows  those  departments  of  knowledge  which  have 
ideas  in  common  or  whose  fields  of  labor  come  into  mutual  con- 
tact, opportunities  to  gain  from  one  another.  Of  the  various 
subjects  within  a  medical  school  anatomy,  histology,  and  em- 
bryology will  always  profit  from  a  close  association  with 
zoology;  physiology  with  chemistry,  physics,  zoology,  botany 
and  psychology;  physiological  chemistry  with  chemistry,  zo- 
ology and  botany;  bacteriology  with  botany;  neurology  and 
psychiatry  with  psychology;  while  general  medicine  has  points 
of  contact  with  all  of  these  divisions  of  knowledge  and  more. 
Indeed  it  is  difficult  to  think  of  any  department  of  medicine, 
whether  scientific  or  clinical,  that  cannot  conceivably  gain  by 
contact  with  a  modern  university.  The  immediate  propinquity 
of  a  university  therefore  cannot  fail  to  be  stimulating  and  up- 
lifting and  broadening  to  a  school  of  medicine.  But  the  bene- 
fits of  association  are  not  to  be  limited  to  the  school  of  medicine, 
for  it  is  capable  of  giving  as  well  as  receiving. 

These  benefits  of  association  have  been  well  presented  by  Pro- 
fessor Paulsen  in  his  chapter  on  "The  unity  of  the  university," 
being  a  part  of  his  book  on  "The  German  universities  and  uni- 
versity study."     He  says: 

"It  is  important,  in  the  first  place,  that  the  teachers  of  all  the 
faculties  should  be  organized  into  a  homogeneous  body.  By  this 
means,  the  mere  outward  environment  gives  one  a  daily  impres- 
sion of  the  unity  of  the  sciences;  the  daily  meeting  is  an  incen- 
tive to  seek  encouragement  and  assistance  in  intellectual  inter- 
course. .  .  .  The  philosopher  cOmes  into  constant  contact  with 
students  of  nature  and  history;  they  mutually  Influence  one  an- 
other. .  .  .  The  jurist,  also,  comes  into  daily  contact  with  the 
historian  or  the  economist,  and  the  physician  with  the  physicist, 
the  chemist  and  biologist;  the  mere  presence  of  those  others  is 
a  challenge  to^  look  beyond  the  limits  of  his  own  science  and  to 
make  comparisons. 

"It  ought  also  to  be  kept  In  mind  how  frequently  the  tran- 
sition Is  made  from  one  science  to  another,  not  infrequently  even 
with  a  total  disregard  of  the  faculty  boundaries :  Lotze  the  phi- 
losopher was  a  physician  and  decent  of  medicine  at  Leipzig 

19 


before  he  was  called  to  the  chair  of  philosophy  at  Gottingen; 
Wundt  also  began  with  medicine,  and  Fechner  was  a  lifelong 
professor  of  physics;  Helmholtz,  physicist  and  physiologist,  had 
completed  his  medical  course  and  was  a  military  surgeon  before 
he  became  a  professor  of  physiology  and  then  of  physics.  .  .  . 
All  these  men,  moreover,  laid  the  foundation  for  such  dual  ca- 
pacity during  their  university  course. 

"This  leads  to  the  further  observation  that  this  intercourse 
of  the  faculties  is  of  no  less  significance  to  the  students  than  to 
the  teachers.  It  is  true  that  the  university  does  not  possess  the 
unity  of  a  school,  It  is  merely  an  association  of  independent 
higher  schools  whose  courses  are  in  a  general  way  coordinate. 
There  is,  however,  a  great  deal  of  overlapping.  A  German  stu- 
dent certainly  will  not  readily  leave  his  university  without  havn 
ing  heard  lectures  outside  of  his  own  faculty,  at  least  without 
having  done  so  occasionally.  .  .  .  The  unity  of  the  university 
by  inviting  the  Inspection  of  other  departments  makes  It  pos- 
sible to  recognize  and  correct  mistakes  In  the  choice  of  courses 
and  professions  before  It  Is  too  late.  .  .  .  Thus  the  unity  of 
university  education  contributes.  In  a  high  degree,  to  Impart  to 
the  academically  educated  classes  the  feeling  of  unity  and  soli- 
darity, the  feeling  of  an  aristocracy  of  Intellect,  an  aristocracy 
which  can  hold  Its  own  against  both  birth  and  wealth.  Exclud- 
ing no  one  who  has  the  ability  to  secure  admission  to  the  aca- 
demic world,  the  university,  as  formerly  the  clergy,  represents 
both  the  unity  and  the  Intellectual  leadership  of  the  people.  .  .  . 
Isolated  professional  schools  have  no  Individual  college  spirit, 
the  society  is  too  limited,  the  point  of  view  too  narrow,  and  de- 
pendency too  great;  only  at  a  university  can  there  be  that  de- 
velopment of  Ideas  In  common  which,  as  the  soul  of  the  corpora- 
tion, gives  It  the  distinctive  character  and  the  self-preservative 
Instinct  of  an  organism." 

The  great  German  clinician,  Friedrlch  Miiller,  professor  of 
medicine  In  Munich,  In  an  address  on  the  study  of  medicine  In 
Germany  before  the  Frele  Studentenschaft  In  Munich  on  May 
8,  1912,  said: 

"V/e  wish  the  medical  student  to  grow  up  within  the  uni- 
versity in  active  Intellectual  and  social  contact  with  the  students 
of  other  faculties,  and  to  receive  incentive  from  all  sides.  We 
wish  for  him  an  opportunity  to  hear  other  lectures,  to  pursue 
other  studies  than  those  of  his  narrow  field,  and  to  develop  into 
a  man  of  general  culture.    A  physician  ought  not  to  be  narrow- 

20 


minded;  he  ought  to  take  his  social  position  among  the  cultured 
men  of  the  nation." 

In  order  that  our  conviction  of  the  benefits  of  intimate  asso- 
ciation between  the  school  of  medicine  and  the  rest  of  the  uni- 
versity may  not  appear  to  be  limited  to  our- 
Views  of  Medi-     selves  alone,  we  have  asked  the  opinion  of  a 
cal  Leaders  of       very  few  of  the  leaders  in  scientific  medicine 
Great  Britain         in  England  and  America,  and  have  permission 
to  quote  them  here. 
Dr.  C.  S.  Sherrington,  Holt  professor  of  physiology  In  the 
University  of  Liverpool,  and  one  of  the  foremost  British  leaders 
In  the  medical  sciences,  writes  as  follows : 

"The  question  It  [our  letter]  asks  regarding  the  relative  ad- 
vantages to  a  school  of  medicine  of  having  close  propinquity  to 
the  rest  of  the  university  of  which  It  Is  a  part  seems  to  me  to 
admit  of  a  very  clear  answer.  If  one  regards  the  school  In  its 
aspect  as  a  place  for  the  scientific  study  of  disease  with  a  view 
to  the  instruction  of  students  and  to  the  furthering  of  knowl- 
edge by  research  and  discovery,  the  school  undoubtedly  benefits 
greatly  from  the  opportunities  for  close  contact  with  the  other 
scientific  schools  of  the  university,  both  those  of  the  pure  sci- 
ences and  those  of  the  applied,  but  quite  especially  the  former. 
This  Is  surely  the  meaning  of  the  advent  of  a  new  era  In  medi- 
cine when  a  university  pure  chemist  (Pasteur)  stepped  over  his 
chair's  frontiers,  in  the  Interests  of  medicine;  or,  to  take  surgery, 
when  Lister  turned  to  following  Pasteur's  biochemical  w^ork 
with  a  view  to  improving  his  own  ward-results. 

"Also,  may  we  not  feel  that  a  school  of  medicine  in  its  turn 
will  contribute  something  to  the  breadth  and  earnestness  with 
which  Its  sister  schools  of  study  proceed  In  the  university,  If  by 
daily  Intercourse  with  them  through  Its  staff  and  students  its 
own  aims  and  difficulties  and  sympathies  are  known  and  recog- 
nized to  be  not  ungermane  to  the  rest? 

"Further,  I  have  myself  long  been  convinced  that  one  of  the 
first  duties  of  every  university,  and  quite  especially  of  every 
large  university,  is  to  leave  no  means  unused  for  bringing  to- 
gether In  their  work  as  well  as  In  their  play  all  sorts  and  condi- 
tions of  their  students.  It  is.  In  my  opinion,  of  the  highest  good 
to  a  student  that  he  should  have  mixed  with  students  outside  as 
well  as  within  his  own  particular  'Fach.'  It  gives  breadth  of 
character  as  well  as  breadth  of  knowledge.     Only  by  providing 

21 


free  mutual  contact  between  its  students  of  medicine,  law,  di- 
vinity, pure  science,  engineering,  teaching,  and  what  not,  can 
university  life  ensure  on  the  average  that  distinction  and  cath- 
olicity of  judgment  and  sympathy  for  others  which  must  be 
recognized  as  one  of  the  best  gifts  which  a  successful  university 
bestows  on  its  alumni — the  acquisition  of  a  broad  understand- 
ing and  kindly  though  critical  respect  for  the  aims  of  their  fel- 
low men  and  women. 

"As  to  the  importance  to  physiology  of  its  work  being  done 
alongside  of  that  of  the  other  natural  sciences,  especially  physics 
and  chemistry  and  biology,  that  is  too  obvious  to  need  mention. 
To  me  it  appears  an  absolute  essential  for  the  prosperity  of  any 
physiology  school.  Without  it  physiology  has  always  lan- 
guished and  become  'dry-as-dust.'  " 

Dr.  W.  H.  Gaskell,  lecturer  in  physiology  in  the  University 
of  Cambridge,  a  man  of  many  years'  experience  within  univer- 
sity circles,  a  member  of  the  Moseley  Commission,  and  one  who 
possesses  a  broad  outlook  over  educational  problems,  writes : 

[The  place  of  physiology  in  the  university]  "Is  in  the  scien- 
tific department  alongside  of  the  chemical,  physical  and  biologi- 
cal laboratories.  The  same  reasoning  applies  to  a  less  degree 
to  all  the  scientific  departments  connected  with  medicine,  such 
as  anatomy,  pathology  and  pharmacology.  For  workers  in  all 
these  departments  It  Is,  to  my  mind,  of  Incalculable  value  that 
the  so-called  non-medical  laboratories  should  be  close  at  hand  so 
that  at  any  moment  they  may  obtain  the  best  advice  from  ex- 
perts in  these  departments.  There  Is  not,  in  my  opinion,  the 
same  absolute  necessity  that  the  hospital  Itself  should  be  In  such 
close  proximity  to  the  scientific  schools  of  the  university,  though 
I  look  upon  such  proximity  as  the  Ideal  for  a  medical  school, 
provided  that  the  situation  of  the  university  does  not  preclude 
the  attainment  by  the  hospital  of  the  best  clinical  teaching.  .  .  . 
Of  course  if  the  circumstances  are  such  that  the  best  clinical 
teaching — both  with  respect  to  the  supply  of  patients  and  the 
quality  of  the  staff — be  obtained  in  a  hospital  situated  close  to 
the  scientific  laboratories,  then  In  my  opinion  you  have  the  ideal 
school." 

Dr.  J.  S.  Haldane,  reader  In  physiology  In  the  University  of 
Oxford  and  fellow  of  New  College,  a  keen  observer  and 
thinker,  writes : 

22 


"On  the  abstract  question  as  to  whether  it  is  desirable  that 
the  medical  school  should  be  close  to  the  other  university  build- 
ings if  at  all  possible,  my  own  opinion  is  a  very  decided  one, 
that  the  advantage  of  such  juxtaposition  is  very  great.  The 
medical  sciences  are  every  year  becoming  more  directly  depen- 
dent upon  physics,  chemistry  and  biology,  and  for  this  reason  it 
seems  clear  that  the  medical  school  ought  not  to  be  separated 
off  from  these  subjects.  I  also  think  that  there  are  still  broader 
educational  grounds  for  keeping  the  study  of  medicine  in  con- 
tact as  far  as  practicable  with  other  university  studies,  includ- 
ing literary  ones.  From  the  experience  of  this  university,  I 
should  say  that  it  is  certainly  good  for  the  university  as  a  whole 
that  the  men  studying  different  subjects  should  be  in  contact 
with  one  another  as  far  as  possible  and  that  a  broader  and 
sounder  education  is  obtained  under  these  circumstances." 

Dr.  Benjamin  Moore,  Johnston  professor  of  biochemistry 
in  the  University  of  Liverpool,  an  active  investigator  in  medi- 
cal science,  an  acute  thinker  in  medical  problems,  who  speaks 
from  the  background  of  an  experience  as  professor  in  the  Char- 
ing Cross  Hospital  Medical  School,  the  Yale  Medical  School, 
and  for  many  years  at  Liverpool,  writes : 

"I  have  no  hesitation  in  saying  that  both  your  medical  school 
and  your  hospital  will  suffer  by  being  cut  off  from  the  university 
geographically — the  school  very  obviously;  the  hospital  less  ob- 
viously so,  but  none  the  less  seriously.  Nothing  has  kept  back 
the  progress  of  practical  medical  sciences  in  your  country 
and  mine  so  much  as  clinical  professors  in  the  university  becom- 
ing purely  professional  practitioners  and  commercial  men  in- 
stead of  remaining  as  scientific  inquirers.  A  university  hospital 
attached  to  a  medical  school  is  something  more  than  a  charitable 
institution  for  attending  on  the  sick  poor;  it  is  an  institution  de- 
voted to  humanity  for  discovering  the  causes  and  means  of  pre- 
vention of  disease.  Unfortunately,  money  and  commercialism 
enter  in  and  physicians  and  surgeons  become  'dollar  hunters'  in 
your  country,  and  'guinea  grubs'  in  mine  with  a  few  honorable 
and  notable  exceptions.  The  atmosphere  of  a  university  is  the 
corrective  for  this,  and  you  lose  this  if  both  hospital  and  medical 
school  are  not  kept  in  close  living  contact  with  all  the  other 
broad  faculties  of  the  university.  Compare  Germany  with  our 
countries  in  this  respect,  and  observe  how  the  physician  or  sur- 
geon there  works  for  love  of  his  subject  and  professional  fame, 

23 


the  most  distinguished  men  being  often  found  in  small  cities, 
but  with  world-famed  university  clinics.  If  you  want  to  replace 
the  God  of  Gold  by  the  God  of  Learning,  you  must  set  up  your 
dwelling  near  the  university  temple.  As  to  physiology  and  bio- 
chemistry, it  is  quite  obvious  that  these  must  gain  by  daily  con- 
tact with  their  colleagues  in  biology  and  chemistry.  In  addi- 
tion, there  is  the  broadening  influence  that  comes  from  meeting 
men  in  other  faculties  altogether  than  medicine  and  science.  If 
there  is  to  be  a  soul  kept  in  science,  we  must  mix  with  philosoph- 
ers and  artists  and  scholars,  or  we  shall  turn  into  mechanics  and 
technicians  and  will  be  incapable  in  the  end  of  any  real  prog- 
ress." 


Dr.   Lewellys   F.   Barker,   professor  of  medicine   in   Johns 
Hopkins    Medical   School,    physician-in-chief 
Views  of  Amer-     of   the   Johns   Hopkins   Hospital,    acknowl- 
ican  Medical  edged  as  one  of  the  broad-minded  American 

Leaders  leaders  both  in  scientific  medicine  and  in  prob- 

lems of  medical  education,  writes : 

"Wherever  such  propinquity  is  possible  and  practically  feas- 
ible, the  advantages  are  numerous.  For  the  advance  of  medi- 
cine it  is  highly  desirable  that  the  subjects  of  the  first  two  years 
of  medicine  shall  be  taught  as  science  departments  of  a  great 
university  In  close  connection  with  the  research  work  of  the 
graduate  school.  It  is  most  helpful  to  the  professors  of  anat- 
omy, physiology,  pharmacology,  pathology  and  Internal  medi- 
cine to  have  easy  opportunity  of  contact  with  the  professors  of 
physics,  chemistry,  biology  and  psychology.  Moreover,  It  is 
highly  desirable  for  the  practical  work  of  a  hospital  and  for  the 
clinical  instruction  of  a  hospital,  that  the  laboratory  department 
of  the  medical  school  be  situated  near  by.  The  workers  in  the 
more  practical  department  should  be  able  without  difficulty  fre- 
quently to  consult  the  workers  In  the  more  strictly  theoretical 
branches.  When  the  work  of  the  primary  branches  and  of  the 
sciences  fundamental  thereto  is  too  far  removed  from  the  work 
of  the  chnlcal  branches,  both  parts  suffer.  The  theoretical  basal 
sciences  need  the  Influence  of  the  practical  branches,  and  vice 
versa.  Of  course  the  problem  of  chnlcal  material  has  to  be  con- 
sidered, but  with  the  rapid  transit  facIHtles  which  now  exist,  in- 
cluding motor  ambulances,  etc.,  the  problem  has  in  recent  years 
assumed  a  new  phase." 

24 


Dr.  David  L.  Edsall,  professor  of  practice  in  the  Plarvard 
Medical  School,  a  representative  of  the  best  type  of  modern 
medical  science,  who  held  a  professor's  chair  for  several  years 
at  the  Medical  School  of  the  University  of  Pennsylvania,  be- 
fore being  called  to  Harvard,  writes: 

"It  is  distinctly  desirable  to  have  the  medical  school  of  a  uni- 
versity in  direct  contact  with  the  university  proper,  geographi- 
cally as  well  as  otherwise.  With  any  medical  school,  however, 
I  think,  in  order  especially  to  keep  the  clinical  staff  at  its  best  in 
efficiency  and  productiveness,  in  order  also  to  increase  the  pro- 
ductiveness and  proficiency  of  the  scientific  (medical)  depart- 
ments, and  especially  in  order  that  the  students  be  properly 
trained  in  the  relations  between  the  scientific  and  clinical  sides 
of  medicine,  the  first  desideratum  is  that  the  hospital  facilities 
mainly  used  by  the  school  be  immediately  adjacent  to  the  medi- 
cal science  departments.  If  this  can  be  done  on  the  grounds  of 
the  university  proper,  it  is  the  best  arrangement  by  far.  ...  I 
would  separate  from  good  hospital  connections,  however,  in 
order  to  get  into  immediate  contact  with  the  general  university 
if  assured  of  the  rapid  provision  of  adequate  hospital  facilities 
on  the  same  grounds." 

Professor  R.  R.  Bensley,  professor  of  anatomy  in  the  Uni- 
versity of  Chicago,  a  medical  man  whose  attention  for  many 
years  past  has  been  directed  to  the  problem  of  the  place  of  the 
laboratory  subjects  of  the  medical  course  in  the  general  curric- 
ulum of  the  university,  writes : 

"The  physical  separation  of  the  medical  school  from  the  uni- 
versity, which  is,  unfortunately,  the  situation  of  most  of  our 
medical  schools,  requires  a  classification  of  the  fundamental 
sciences  into  medical  and  non-medical,  which  is  at  once  arbi- 
trary, illogical  and  wasteful:  arbitrary  and  illogical  because  it 
separates  subjects,  such  as  anatomy  and  zoology,  or  chemistry 
and  biochemistry,  which  are  really  parts  of  the  same  general 
scientific  group,  and  those  which  are  contiguous  and  mutually 
dependent  fields  of  inquiry,  such  as  psychology  and  neurology; 
wasteful,  because  it  requires  the  expensive  duplication  of  depart- 
ments to  insure  that  neither  the  medical  school  on  the  one  hand, 
nor  the  university  on  the  other,  may  suffer.  ...  It  must  be 
borne  in  mind  that  the  medical  school  will  bring  much  to  the 
university  as  well  as  receive  benefit  from  the  university.     Bac- 

25 


teriology  Is  as  important  to  botany  as  to  medicine.  Hygiene  Is 
as  much  a  part  of  a  broad  general  education  as  of  a  medical 
education.  Anatomy,  physiology,  and  pathology  have  won 
their  place  as  general  undergraduate  scientific  studies  in  those 
institutions  which  have  been  able  to  offer  opportunities  for  study 
in  these  departments  In  the  undergraduate  work.  The  recent 
work  on  serum  reactions  and  on  the  nature  of  immunity  has  as 
much  bearing  on  general  biological  science  as  on  the  prevention 
of  disease.  These  sciences  flourish  best  in  an  environment  which 
gives  them  at  once  the  support  of  the  cHnlcal  faculties  which  are 
dependent  on  them,  and  that  of  the  general  body  of  scientific 
workers  of  the  Institution,  on  whose  work  they  are  in  turn  de- 
pendent." 

Dr.  George  E.  Shambaugh,  assistant  professor  of  laryngol- 
ogy and  otology  In  Rush  Medical  College,  which  is  affiliated 
with  the  University  of  Chicago,  one  of  the  few  American  prac- 
titioners of  his  specialty  who  has  spent  much  time  in  the  labora- 
tory in  the  scientific  study  of  the  fundamental  problems  of  otol- 
ogy, writes : 

"I  am  strongly  of  the  opinion  that  for  those  universities  which 
are  planning  to  develop  a  real  university  department  of  medi- 
cine, the  entire  medical  school  should  be  developed  in  proximity 
to  the  remainder  of  the  university.  If  the  ideals  of  university 
Instruction  where  'scientific  investigation  is  to  be  a  prominent 
feature'  are  to  dominate  the  clinical  Instruction  in  medicine  as 
they  already  do  the  fundamental  sciences  In  our  leading  medical 
schools,  then  the  inspiration  and  assistance  that  will  come 
through  the  geographical  union  with  other  great  scientific  de- 
partments of  the  university  cannot  be  overestimated.  On  the 
other  hand,  the  gain  to  such  university  departments  as  physi- 
ology, psychology  and  pathology  by  proximity  to  teaching  re- 
search hospitals  will,  of  course,  be  very  great. 

"There  are  still  those,  especially  in  clinical  medicine,  who  are 
not  able  to  admit  that  the  introduction  of  university  methods 
and  ideals  In  the  teaching  of  clinical  medicine  Is  an  advantage 
over  the  methods  and  ideals  existing  in  our  proprietary  medical 
schools.  These  men  are  anxious  to  have  the  detached  medical 
school  called  the  university  department  of  medicine,  but  they 
oppose  the  Introduction  of  those  methods  and  ideals  which 
alone  can  make  It  a  bona  fide  university  department  of  medicine. 

"The  most  serious  barrier  to  the  development  in  this  country 
of  a  university  department  of  medicine  from  the  existing  type  of 

26 


medical  school  is  the  geographical  separation  of  the  medical 
school  from  the  remainder  of  the  university." 

Dr.  Joseph  L.  Miller,  associate  professor  of  medicine  in 
Rush  Medical  College,  editor  of  the  Archives  of  Internal  Medi- 
cine, and  a  physician  of  high  clinical  attainments,  writes : 

"It  seems  to  me  highly  important  that  the  university,  the  medi- 
cal school  and  the  university  hospital  be  on  the  same  ground.   First 
of  all,  It  is  going  to  permit  of  any  student  who  wishes  to  do  any 
Investigation  In  the  laboratories  while  studying  medicine  to  be 
able  to  carry  this  out  without  a  great  deal  of  waste  of  time.     I 
believe  many  of  our  medical  students  have  the  time  and  inclina- 
tion to  continue  to  do  some  advanced  work  In   fundamental 
branches,  we  will  say  physiology,  during  their  medical  years, 
provided  proper  facilities  are  offered,  and  I  believe  this  arrange- 
ment of  all  the  buildings  on  the  same  ground  would  be  an  im- 
portant factor  and  facilitate  work  of  this  sort.     Furthermore, 
it  permits  a  better  Interchange  of  ideas  and  a  closer  acquaintance- 
ship of  the  man  in  the  medical  department  and  the  pure  scien- 
tist.   Finally,  to  my  mind  one  of  the  most  important  factors  is, 
that  a  university  like  Columbia  would  give  a  certain  atmosphere 
to  the  school,  provided  it  was  adjacent  to  it,  which  would  be  a 
considerable  factor  in  inspiring  the  clinical  man  to  do  a  higher 
class  of  scientific  work.  .   .   .  Any  other  arrangement  It  seems 
to  me  must  be  considered  more  or  less  as  a  makeshift  guided 
probably  by  purely  financial  reasons  or  inability  to  obtain  a 
site." 

Dr.  Joseph  A.  Capps,  associate  professor  of  medicine  In  Rush 
Medical  College,  whose  large  experience  as  a  consulting  phy- 
sician has  qualified  him  to  speak  of  the  training  of  a  clinician, 
writes : 

"I  can  declare  myself  emphatically  in  favor  of  such  a  com- 
bination [the  medical  school  and  hospital  with  the  rest  of  the 
university]  on  several  grounds.  First,  economically,  there  is  a 
tremendous  saving  by  uniting  the  first  years  of  the  medical 
school  with  the  science  department  of  the  university.  Unless 
some  very  great  objection  exists  to  the  teaching  of  medical  stu- 
dents of  the  first  two  years  In  the  university  proper.  It  would 
seem  to  be  the  greatest  waste  and  extravagance  to  duplicate  the 
buildings,  equipment,  and  teachers  In  the  scientific  department 
of  the  university  and  medical  school.     Secondly,'  the  effect  on 

27 


the  university  teachers,  I  think,  is  on  the  whole  beneficial.  The 
mere  teaching  of  the  routine  subjects  in  the  first  two  years  of 
the  medical  school  may  not  in  itself  be  of  any  special  advantage 
to  the  teachers,  but  contact  with  the  teachers  of  medicine  and 
with  medical  problems  is  bound  to  suggest  good  problems  for 
investigative  work.  In  the  third  place,  the  effect  upon  the 
teachers  in  the  medical  school  of  working  in  the  university  is 
unquestioned.  The  medical  teachers  are  bound  to  benefit  tre- 
mendously from  daily  contact  with  university  men  who  are 
working  in  the  sciences.  The  association  of  the  teachers  of 
practical  medicine  with  the  teachers  of  science  is  also  most  help- 
ful in  promoting  the  study  of  the  border  line  problems,  which 
require  the  combined  work  of  the  laboratory  and  the  bedside. 
Finally,  students  themselves  must  derive  benefit  throughout 
their  medical  course  in  the  close  association  of  scientific  teaching 
with  that  of  the  practice  of  medicine.  Such  an  association  will 
develop  more  research  workers  than  could  be  developed  by  a 
separation  of  university  and  school." 

Dr.  George  N.  Stewart,  professor  of  experimental  medi- 
cine and  director  of  the  H.  K.  Gushing  Laboratory  for  Experi- 
mental Medicine,  of  Western  Reserve  university,  a  man  who 
possesses  a  keen  vision  Into  the  applications  of  physiology  to  the 
problems  of  clinical  medicine,  writes : 

"I  think  there  Is  only  one  answer  to  the  question  propounded. 
Mutual  gain,  I  should  say,  Is  not  only  probable  but  certain  to  re- 
sult from  bringing  the  medical  school,  including  the  hospital, 
Into  close  topographical  contact  with  the  rest  of  the  university. 
Of  the  advantages  to  the  university,  I  shall  not  presume  to 
speak.  But  the  measure  of  the  gain  to  the  medical  school  can 
probably  be  estimated  by  none  so  well  as  those  who,  like  the 
present  writer,  have  suffered  and  are  daily  suffering  from  the 
disadvantages  of  physical  separation.  A  while  ago  these  dis- 
advantages were  not  so  obvious.  Medicine,  at  least  as  studied, 
taught  and  practised  In  the  average  school  and  hospital,  had 
few  points  of  contact  with  the  various  disciplines  of  the  aca- 
demic, particularly  of  the  scientific,  departments.  The  profes- 
sors and  students  of  the  academic  departments  were  still  less 
aware  that  medicine  held  anything  of  interest  for  healthy  human 
beings.  All  that  Is  changed  to-day,  and  those  who  are  about  to 
build  should  remember  that  the  change  is  still  going  on  and  will 
be  even  more  obvious  to-morrow.     The  science  of  medicine  Is 

28 


now  recognized  by  its  most  enlightened  and  successful  culti- 
vators and  more  and  more  by  the  educated  lay  public  as  a  branch 
of  biology,  whose  progress  is  absolutely  bound  up  with  the 
progress  of  chemistry  and  physics,  of  animal  and  plant  mor- 
phology and  physiology,  and  which  has  important  relations  to 
psychology  and  even  to  sociology  and  political  economy.  And 
it  is  perfectly  understood  that  the  chemistry  and  physics  which 
avail  for  the  progress  of  medicine  must  be  the  best  and  freshest 
output  of  the  laboratories  and  not  an  inferior  grade  ground 
down  fine  for  easy  assimilation  by  hard-worked  practitioners 
and  none  the  worse  for  being  a  little  out  of  date.  The  physi- 
ologists, the  pharmacologists,  the  pathologists,  the  wide  awake 
and  progressive  clinicians  of  the  hospital  should  therefore  be  so 
near  the  physicists  and  chemists,  yes  and  so  near  the  mathema- 
ticians and  the  psychologists  for  that  matter,  that  far  from  hav- 
ing to  make  a  special  effort,  to  cancel  engagements  and  travel 
several  miles,  in  order  to  meet  an  academic  colleague  whose  aid, 
perhaps  entailing  only  a  five-minute  interview,  may  be  invaluable 
to  them,  and  invaluable  at  a  particular  moment,  they  may  have 
every  chance  of  stumbling  against  him  on  the  campus,  or  even 
in  a  fit  of  fruitful  abstraction  wandering  into  his  laboratory  in- 
stead of  their  own. 

"It  is  unnecessary  to  labor  this  point.  There  are  many  ways 
in  which  physical  propinquity  will  help  the  different  departments 
to  tone  each  other  up.  The  greater  accessibility  of  the  libraries, 
and  the  more  intimate  contact  with  the  business  organization  of 
the  university  which  would  be  brought  about  by  the  location  of 
the  medical  school  on  the  university  campus  are  very  consider- 
able advantages  in  my  opinion.  I  will  end  by  saying  that  the 
above  conclusions,  although  I  think  they  could  be  deduced  by 
general  reasoning  from  the  abstract  proposition  which  you  sub- 
mitted, are,  so  far  as  I  am  concerned,  the  fruit  of  a  not  incon- 
siderable experience  with  both  arrangements." 

Dr.  J.  Gordon  Wilson,  professor  of  otology  in  the  North- 
western University  Medical  School,  one  of  the  best  representa- 
tives of  the  scientific  investigator,  who  sees  the  broad  bearings 
of  his  medical  specialty,  writes : 

"I  received  my  medical  education  at  a  school  where  the  medi- 
cal department  with  its  hospitals  was  immediately  adjacent  to 
the  other  university  departments.  I  spent  several  years  in  a 
university  where  the  university  proper  and  the  first  two  years  of 
medical  studies  were  in  one  campus,  while  the  hospitals  with  the 

29 


last  two  years  were  several  miles  away.  I  am  now  In  a  fully 
equipped  medical  school  situated  at  a  considerable  distance  from 
the  university  proper  with  the  departments  of  chemistry,  physics 
and  psychology. 

"My  experience  has  led  me  to  recognize  the  great  advantage 
of  a  close  association  of  the  medical  school  with  the  scientific 
faculties  of  the  university.  The  cooperation  of  Investigators  In 
medicine  with  scientific  Investigators  in  other  fields  is  becoming 
every  day  of  more  Importance. 

"To  the  teacher  and  especially  the  investigator  In  the  medical 
faculty,  the  wider  views  to  be  obtained  by  the  close  intercourse 
with  members  of  the  scientific  groups  are  of  the  utmost  impor- 
tance. The  viewpoint  thus  obtained  and  the  knowledge  of  ac- 
tivities In  other  sciences  are  not  to  be  gained  so  efficiently  by 
even  a  wide  range  of  reading.  There  Is  ever  present  the  neces- 
sity of  discussing  with  authorities  In  physics,  chemistry  or  psy- 
chology some  phase  of  the  problem  of  disease  In  man. 

"Further  there  Is  the  advantage  to  the  medical  student  of  be- 
coming less  a  school-man  and  more  a  university-man  with  a 
broader  outlook  on  the  problems  of  life — an  advantage  gained 
by  the  subtle  Influence  which  Is  Involuntarily  and  unconsciously 
acquired  from  association  with  his  fellows  In  other  faculties." 

Dr.  Graham  Lusk,  professor  of  physiology,  formerly  in  the 
Yale  and  the  University  Bellevue  Medical  Schools,  now  in  Cor- 
nell University  Medical  College,  a  man  of  international  repute 
in  his  science  and  of  wide  acquaintance  with  the  problems  of 
medical  education,  especially  the  relations  of  medical  schools 
and  hospitals,  writes : 

"I  would  say  that,  given  favoring  conditions  for  hospital  de- 
velopment, all  the  university  buildings  would  best  form  a 
group." 

Dr.  Henry  H.  Donaldson,  for  several  years  professor  of 
neurology  In  the  University  of  Chicago,  and  now  head  of  the 
department  of  neurology  In  the  Wistar  Institute  of  Anatomy 
and  Biology,  writes : 

"With  the  growth  of  laboratories  and  apparatus  and  the  de- 
vices for  communication,  the  fundamental  importance  of  per- 
sonal contact  in  the  advance  of  knowledge  has  suffered  some 

30 


neglect.  Specialization  requires  to  be  supplemented  by  coop- 
eration. The  passing  comment  or  appreciation,  the  incidental 
conversation,  are  most  potent.  They  prevent  useless  labor  and 
reveal  unsuspected  relations.  This  form  of  intellectual  stimu- 
lus, always  difficult  to  cultivate  even  under  favorable  conditions, 
becomes  well  nigh  impossible  in  the  face  of  geographical  sepa- 
ration. The  farther  the  sciences  divide,  the  more  imperative  is 
the  concentration  of  all  workshops  at  one  spot.  I  hope  Colum- 
bia will  be  able  to  solve  her  problem  in  the  interests  of  pos- 
terity." 

At  the  beginning  of  this  communication  we  called  attention 
to  the  fact  that  in  the  discussion  of  the  future  of  the  school  of 

medicine  and  the  university  hospital,  the  In- 
Views  of  terests  of  the  rest  of  the  university  had  been 

Columbia  Pro-      almost  wholly  overlooked.     In  view  of  this 
fessors  we  have  been  interested  In  learning  the  views 

of  our  colleagues  at  Mornlngslde  Heights, 
whose  field  of  work  touches  that  of  the  medical  school.  With- 
out exception,  they  have  welcomed  the  idea  of  a  possible  closer 
association  of  the  school  with  their  respective  departments  and 
others  allied  to  theirs. 

Thus  Professor  Boas,  of  the  department  of  anthropology, 
writes : 

"It  seems  to  my  mind  that  the  location  of  the  two  branches 
of  the  university  near  together  seems  to  be  entirely  advanta- 
geous, on  account  of  the  possibility  of  mutually  profiting  by  par- 
ticipation in  our  work.  I  appreciate  the  practical  difficulties 
which  are  In  the  way.  It  seems  to  me,  however,  that  If  It 
were  possible  to  place  anatomy  and  physiology  near  the  uni- 
versity, very  great  benefits  might  accrue  to  both  institutions. 
We  need  very  much  the  opportunity  for  work  In  these  branches 
In  the  university,  which  would  be  greatly  facilitated  if  they  were 
located  right  here.  This  would  be  particularly  beneficial  to  psy- 
chology and  anthropology.  I  go  so  far  that  I  should  like  to  see 
a  building  devoted  entirely  to  the  needs  of  psychology,  physi- 
ology and  anthropology.  I  believe  that  the  advantages  for  the 
medical  school  would  also  be  very  important,  particularly  inas- 
much as  the  young  students  would  remain  more  closely  In  touch 
with  the  broader  university  spirit,  and  would  not  so  early  con- 

31 


centrate  their  attention  entirely  upon  the  practical  needs  of  their 
final  examination.  Thus  could  be  broadened  the  scientific  inter- 
ests of  your  graduates." 

Professor  Wilson,   of  the  department  of  zoology,  writes : 

"As  far  as  my  own  department  of  zoology  is  concerned — and 
I  think  the  same  may  be  said  of  a  number  of  other  departments, 
for  instance,  that  of  botany — these  advantages  [of  geographi- 
cal propinquity  of  the  medical  school,  hospital,  and  the  rest  of 
the  university]  would  be  in  some  respects  very  great.  There 
are  in  the  medical  school  as  at  present  organized  at  least  four 
departments  which  represent  subjects,  any  one  of  which  may 
form  a  desirable  minor  subject  for  a  doctor's  or  master's  degree, 
taken  by  students  whose  major  subject  lies  in  the  university  de- 
partments in  question.  These  departments  are  those  of  anat- 
omy, bacteriology,  physiology  and  physiological  chemistry.  As 
you  are  aware,  physiology  has  frequently  been  taken  as  a  minor 
by  students  of  zoology  and  the  same  may  be  said  also  of  the 
other  departments  which  I  have  mentioned.  The  advantages  of 
a  close  association  between  these  departments  and  my  own  are  so 
obvious  as  to  require  no  discussion.  From  every  point  of  view 
it  would  be  very  much  to  our  advantage  could  the  work  of  these 
departments  be  carried  on  in,  laboratories  that  are  close  to  our 
own.  As  matters  now  stand,  much  time  is  lost  by  the  necessity 
that  our  students  find  themselves  under  of  going  so  far  to  carry 
on  their  work  in  the  medical  school. 

"Apart  from  the  student  point  of  view, 'the  advantages  of  a 
closer  association  between  the  instructors  in  our  department  and 
in  those  of  the  medical  school  are  evident.  For  these  reasons 
and  others  which  might  be  mentioned,  I  should  be  heartily  in 
favor  of  any  action  looking  toward  the  transfer  of  the  medical 
school  to  a  site  upon  or  near  the  university  grounds." 

Professor  Morgan,  of  the  department  of  zoology,  writes: 

"Without  attempting  to  speak  of  the  advantages  to  the  uni- 
versity in  general  that  might  accrue  if  the  medical  school  were 
situated  in  this  vicinity,  I  may  be  permitted  to  express  an  opinion 
as  to  the  advantages  to  the  zoological  department  that  might  be 
hoped  for.  Many  of  our  undergraduate  students  look  forward 
to  a  career  in  medicine.  The  importance  to  them  of  their 
zoological  work  and  the  seriousness  of  the  work  might  be 
brought  home  if  the  body  of  medical  students  mingled  more 

32 


freely  with  the  undergraduates.  But  it  is  in  regard  to  the  more 
advanced  students  and  to  the  members  of  our  staff  itself  that  I 
wish  especially  to  speak.  The  medical  men  are  in  daily  touch 
with  actual  problems  of  humanity.  Our  students  and  we  our- 
selves live  in  a  rather  academic  atmosphere  where  the  applica- 
tions of  our  studies  are  somewhat  remote.  The  crossing  of 
these  two  currents  cannot  be  without  beneficial  results.  It  is, 
however,  the  investigator  in  the  medical  field  that  is  most  es- 
sential to  us.  There  is  only  an  artificial  barrier  that  separates 
the  investigator  in  physiology,  pathology,  bacteriology  and  anat- 
omy from  the  investigator  in  the  zoological  field.  We  need  each 
others'  experience  at  every  turn.  As  it  is  impossible  to  duplicate 
in  the  university  the  work  done  by  the  advanced  students  in  the 
medical  sciences  we  are  correspondingly  isolated  from  a  group 
of  men  whose  work  is  closely  akin  to  our  own.  This  seems  to 
me  to  be  the  chief  argument,  from  our  point  of  view,  for  bring- 
ing the  medical  school  nearer  to  us." 

Professor  Cattell,  of  the  department  of  philosophy  and 
psychology,  writes : 

"It  seems  to  me  that  psychology  suffers  at  universities  such  as 
Columbia,  Harvard  and  the  Johns  Hopkins  from  the  fact  that 
the  medical  school  is  so  far  distant  as  to  be  almost  a  separate  in- 
stitution. Union  Theological  Seminary,  which  is  a  separate  cor- 
poration, seems  to  be  more  nearly  an  educational  part  of  Colum- 
bia University  than  the  College  of  Physicians  and  Surgeons,  and 
we  have  more  to  do  with  its  professors  and  students.  Both  the 
fundamental  sciences  given  at  the  medical  school,  such  as  physi- 
ology and  anatomy,  and  the  clinical  subjects  such  as  neurology 
and  psychiatry,  are  of  great  importance  for  students  of  psychol- 
ogy ;  they  would  be  more  likely  to  follow  them  and  to  gain  more 
from  them  if  the  medical  school  were  adjacent  to  us  and  were  an 
integral  part  of  our  work,  than  under  existing  conditions.  At 
present  we  regard  it  as  desirable  to  give  In  the  department 
courses  In  abnormal  psychology,  which  ought  not  to  be  neces- 
sary, if  the  courses  In  the  medical  school  were  available,  and  to 
arrange  for  our  students  to  attend  clinics  in  different  parts  of 
the  city,  when  it  would  doubtless  be  better  If  there  were  a  well 
organized  hospital  and  clinics  adjacent  to  us  and  under  the  con- 
trol of  the  university." 

Professor  Woodworth,  of  the  department  of  philosophy  and 
psychology,  writes : 

33 


"The  department  of  psychology  would  expect  distinct  advan- 
tages from  the  neighborhood  of  the  medical  school.  We  fre- 
quently have  students  who  wish  to  study  the  brain  or  nervous 
and  mental  diseases,  as  well  as  general  physiology.  At  present 
it  is  difficult  to  make  a  combination  in  the  student's  program 
between  our  work  and  that  at  the  medical  school  and  thus  the 
neighborhood  of  the  medical  school  would  be  a  distinct  advan- 
tage. Furthermore,  I  believe  the  opportunity  for  frequent  in- 
tercourse between  our  teaching  staff  and  the  staff  of  the  related 
departments  in  the  medical  school  would  be  of  considerable  ad- 
vantage to  us. 

"On  the  other  side,  I  believe  that  occasionally  we  should  be 
able  to  contribute  something  to  the  education  of  the  medical 
student.  Those  who  are  preparing  for  special  work  in  nervous 
and  mental  diseases  often  come  to  us  to  take  some  psychology, 
but  they  find  the  long  journey  a  hindrance  and  I  have  no  doubt 
that  many  who  would  profit  by  our  courses  are  unable  to  avail 
themselves  of  them  at  present." 

It  may  be  pertinent  here  to  call  to  your  attention  your  own 

words  uttered  on  January  17,   19 10,  in  an- 

View  of  Presi-       nouncing  to  the  faculty  of  medicine  the  proj- 

dent  Butler  ect  of  the  trustees  for  the  reconstruction  of 

the  medical  school  at  Mornlngside  Heights. 

"I  cannot  refrain  from  pointing  out  what  I  believe  to  be  the 
immense  educational  advantage  of  bringing  about  a  physical 
unity  between  the  medical  school  and  the  rest  of  the  univer- 
sity. The  consequent  close  association  with  other  university 
teachers  and  students  on  the  part  both  of  members  of  the  teach- 
ing staff  and  members  of  the  student  body  at  the  medical  school 
cannot  fail  to  be  in  every  way  advantageous.  A  closer  alliance 
will  be  formed  between  the  work  of  men  engaged  In  research 
under  the  faculty  of  pure  science  and  those  engaged  In  research 
under  the  faculty  of  medicine.  The  medical  students  will  be 
able  to  enjoy,  what  they  have  not  heretofore  had,  namely,  the 
pleasure  and  profit  of  academic  residence  and  of  close  academic 
association." 

Dean  Woodbridge  has  recently  written : 

"I  am  of  the  opinion  that  there  Is  decided  gain  both  educa- 
tionally and  economically  In  having  the  various  departments  of 

34 


the  university  in  the  same  geographical  location.  The  inter- 
relations between  the  various  departments  are  growing  to  be 
yearly  more  intimate  and  there  is  a  strengthening  of  university 
spirit  by  the  presence  in  one  locality  of  the  important  branches 
of  the  institution.  Indeed,  if  the  question  is  raised  as  a  purely 
theoretical  question  I  do  not  see  how  it  is  debatable." 

In  one  special  field  of  the  work  of  the  university  physical  as- 
sociation is  especially  desirable,  namely,  in  the  school  of  sanitary 
science  and  public  health  which  Columbia 
Medical  School  must  ere  long  establish.  After  approving  ac- 
and  School  of  tion  by  the  medical  faculty  in  1903  and  1908 
Sanitary  the  matter  of  inaugurating  such  a  school  was 

Science  thoroughly   considered   by   a   committee   ap- 

pointed in  December,  1908.  This  committee 
consisted  of  Professors  Lambert,  Lee  and  Starr  and  Dr.  Dit- 
man  of  the  College  of  Physicians  and  Surgeons  and  Professors 
Burr,  Calkins,  Devine,  Farrand,  Goetze,  Seligman,  Tombo,  and 
T.  D.  Wood,  representing  a  wide  range  of  interests  in  the  uni- 
versity outside  the  micdical  school.  On  April  26,  1909,  this 
committee  submitted  its  report  and  advised  the  establishment 
of  a  school  of  sanitary  science  and  public  health,  distinct  from 
existing  schools  but  making  use  of  the  equipments  of  several  of 
them.  If  such  a  school  were  established  instruction  in  it  would 
be  shared  by  at  least  the  departments  of  physiology,  biological 
chemistry,  pathology,  and  bacteriology  now  at  59th  Street  and 
the  departments  of  civil  engineering,  anthropology,  chemistry, 
political  science,  administrative  law,  social  science  and  psy- 
chology now  at  Morningside  Heights.  It  would  be  exceedingly 
difficult  to  adjust  the  work  of  the  students  In  their  several 
courses  without  Involving  much  loss  of  time  due  to  the  necessity 
of  traveling  back  and  forth  between  the  two  sites.  Moreover, 
the  school  would  suffer  seriously  from  the  lack  of  unification 
and  solidarity  that  is  essential  to  the  success  of  any  such  institu- 
tion. Apropos  of  this  Professor  Burr,  of  the  department  of 
civil  engineering,  writes : 

"If  there  should  eventually  be  a  department  or  school  of 
sanitary  science  established  here,  that  department  would  unques- 

35 


tionably  greatly  benefit  by  having  the  College  of  Physicians  and 
Surgeons  in  near  vicinity  to  it.  I  hope  such  a  department  or 
school  may  eventually  be  established." 

Mr.   Daniel   D.   Jackson,   lecturer  in   sanitary   engineering, 

writes: 

"There  is  great  need  of  better  schools  for  the  training  of  pub- 
lic health  officers  and  Inspectors,  and  the  public  is  now  beginning 
to  demand  that  such  men  shall  be  specifically  trained  for  the 
Important  duties  which  they  have  to  perform.  Harvard  and  the 
University  of  Pennsylvania  have  already  started  such  courses, 
but  Columbia  has  so  far  only  her  course  in  sanitary  engineer- 
ing. 

"With  the  College  of  Physicians  and  Surgeons  In  close  prox- 
imity, it  would  be  possible  to  establish  courses  in  public  health 
leading  to  the  degree  of  C.S.  (certified  sanitarian)  and  D.P.H. 
(doctor  of  public  health).  This  union  would  also  admit  of 
graduate  courses  In  advanced  protozoology,  bacteriology,  physi- 
ology and  physiological  chemistry,  which  would  be  mutually 
beneficial  and  serve  to  add  strength  to  the  courses  in  biology, 
chemistry  and  sanitary  engineering,  as  well  as  to  the  variety  and 
scope  of  subjects  taught  in  the  College  of  Physicians  and  Sur- 
geons. Sanitary  science  and  the  sanitary  arts  which  are  now  be- 
ing taught  in  the  Schools  of  Mines,  Engineering  and  Chemistry 
will  be  greatly  strengthened  by  the  proposed  union,  and  the  Col- 
lege of  Physicians  and  Surgeons  will  be  assisted  in  its  hygiene 
and  preventive  medicine.  It  may  be  beneficial  to  train  the  medi- 
cal student  more  thoroughly  in  the  causes  and  prevention  of 
diseases,  and  give  him  an  optional  opportunity  to  take  courses 
in  advanced  chemistry  and  biology. 

"I  thoroughly  believe  that  the  separation  of  the  two  schools 
at  a  distance  which  cannot  be  traversed  between  courses  Is  a 
detriment  in  the  economy  and  efficiency  of  both  Institutions." 

Our  thesis  then  is,  that  from  the  standpoint  of  the  ideal 
school  of  medicine,  the  future  College  of  Physicians  and  Sur- 
geons,   together   with   the    future   university 
View  of  Medi-      hospital,  ought  to  be  situated  in  the  imme- 
cal  Faculty  diate  vicinity  of  the  other  schools  of  the  uni- 

versity. It  will  be  recalled  that  on  January 
17,  19 16,  the  faculty  of  medicine  put  itself  on  record  in  favor 
of  such  a  disposition  of  the  school  as  follows : 

36 


"Resolved,  That  In  the  judgment  of  the  faculty,  the  trans- 
feral will  be  for  the  best  interests  of  the  future  development  of 
the  school  of  medicine  at  Columbia." 

The  situation  created  in  connection  with  the  proposed  trans- 
feral was  referred  at  the  time  to  a  committee  of  the  faculty  of 
medicine  consisting  of  Dean  Lambert  and  Professors  Hunting- 
ton, Blake,  Janeway,  Wood  and  MacCallum.  This  committee 
reported  at  length  to  the  faculty  on  October  17,  19 10.  Not 
the  least  interesting  portion  of  their  report  consists  of  the  com- 
mittee's replies  to  eight  objections  that  had  been  proposed  to 
the  proposition  of  removal  to  Morningside  Heights.  Among 
its  final  conclusions  and  recommendations,  the  committee  sub- 
mitted the  following : 

"That  the  College  should  move  from  59th  Street  and  that 
the  proposed  site  at  i  T6th  Street,  provided  the  additional  space 
for  an  university  hospital  be  secured,  offers  the  greatest  num- 
ber of  possible  advantages  compared  with  any  plans  of  develop- 
ment which  have  been  proposed." 

The  report  of  the  committee  was  made  a  special  order  for  dis- 
cussion at  a  subsequent  meeting  of  the  faculty.  The  discus- 
sion was,  however,  finally  postponed  indefinitely  because  the 
immediate  failure  to  obtain  the  necessary  funds  to  effect  a  re- 
moval and  the  subsequent  alliance  with  the  Presbyterian  Hos- 
pital turned  the  thoughts  of  the  faculty  to  a  different  disposi- 
tion of  the  school.    This  we  believe  to  be  wholly  unwise. 

In  our  endeavor  to  be  impartial  we  have  searched  widely  for 
objections  to  our  main  thesis.  We  confess  that  we  can  find  no 
opposing  argument  that  Is  of  serious  moment.  It  may  be  said 
that  we  have  presented  merely  an  Ideal  proposition,  a  Utopian 
scheme,  acquiescence  in  which  Is  easy,  but  that  the  university  Is 
obliged  to  face  a  very  practical  financial  situation  and  that  this 
must  decide  the  future  of  the  school  of  medicine.  But  ought 
this  to  be  so?  Ought  the  present  lack  of  money  to  Influence  a 
university  of  such  high  Ideals  as  is  Columbia,  and  one  which  In 
the  achievement  of  its  Ideals  has  already  solved  so  many  finan- 
cial problems  as  has  Columbia,  now  to  abandon  an  ideal  and 

37 


accept  something  that  is  obviously  Inferior?  The  College  of 
Physicians  and  Surgeons  has  never  assumed  in  the  world  of 
learning  the  high  position  which  is  its  just  due  by  reason  of  its 
seat  in  the  metropolis  of  America  and  its  connection  with  Amer- 
ica's greatest  university.  For  a  period  of  just  one  hundred 
years  it  has  been  receiving  Columbia's  aid  in  various  ways.  In 
1 8 13  it  was  enriched  by  the  discontinuance  of  Columbia's  school 
of  medicine  and  the  transfer  of  the  latter's  faculty  to  the  newer 
rival.  In  i860  it  formed  an  alliance  with  the  university.  This 
alliance  grew  into  a  definite  merger  in  1891.  Thus  for  a  cen- 
tury the  medical  school  has  been  approaching  a  university  ideal. 
But  geographical  isolation  will  always  hamper  It  In  the  fulfill- 
ment of  Its  aspirations.  We  believe  that  geographical  propin- 
quity, on  the  other  hand,  with  all  that  that  implies  will  immeas- 
urably augment  the  prestige  of  the  school  in  the  learned  world 
and  will  prove  to  be  the  final  essential  factor  in  enabling  it  to 
become  one  of  the  world  leaders  of  scientific  medicine.  The 
present  Is  the  critical  time.  Ought  Columbia  to  be  satisfied  with 
anything  less  than  the  best  ? 

Respectfully, 

Frederic  S.  Lee, 
Frank  H.  Pike. 


38 


COLUMBIA   UNIVERSITY 

This  l)uok  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing, 
as  provided  by  the  rules  of  the  Library  or  by  special  ar- 
rangement with  the  Librarian  in  charge. 

DATE  BORROWED 

DATE  DUE 

DATE  BORROWED 

DATE  DUE 

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C2B(638)M50 

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